Pollypills with or without aspirin in person without cardiovascular disease

The prevalence of the cardiovascular disease is dramatically increasing with about 18 million deaths per year globally; the leading causative but modifiable risk factors majorly being Elevated Blood Pressure and LDL Cholesterol levels. Polypills are a blend of lipid and blood pressure-lowering medications. Aspirin that is used as a hallmark treatment in patients with cardiovascular conditions has proven value but its solitary use or as a part of polypills is not known. S. Yusuf and colleagues conducted research titled “Polypill with or without Aspirin in Persons without Cardiovascular Disease” published in the New England Journal of Medicine. The summary of this study is given below:

Objective:

To study the efficacy and safety of treatment using polypills comprising of a statin, numerous blood pressure decreasing medications, sole administration of aspirin, or their combination in reducing the rate of cardiovascular events among individuals without any cardiovascular disease.

Methods:

This is a randomized, double-blinded, placebo-controlled trial conducted using a 2-by-2-by-2 factorial design and involved 5713 participants with no history of cardiovascular disease but increased INTERHEART Risk scores.

Three randomized comparisons were carried out.

1.  The first trial involved the effect of treatment using polypills (40 mg of simvastatin, 100 mg of atenolol, 25 mg of hydrochlorothiazide, and 10 mg of ramipril) compared with placebo on cardiovascular outcomes.
2.  The second randomized comparison was between enteric-coated aspirin at a dose of 75 mg per day, as compared with placebo.
3.  The third comparison was between the effect of polypill plus aspirin as compared with double placebo as well as the effect of treatment of Vitamin D at a monthly dose of 60,000 IU as compared with placebo.
   The main outcome assessed through polypill-alone and polypill-plus-aspirin comparisons were death from cardiovascular causes, stroke, myocardial infarction, heart failure, resuscitated cardiac arrest, or revascularization. The primary outcome for aspirin comparison was death from cardiovascular causes, myocardial infarction, or stroke. Safety was also assessed.

Findings:

The study reports that the combined treatment involving polypill and aspirin led to a decreased incidence of cardiovascular events as compared to placebo among the participants not having any cardiovascular conditions but who had an intermediary cardiovascular risk. Additionally, lifestyle changes in addition to the polypill treatment can provide a wider approach as a preventative measure against cardiovascular disorders. The study also found a higher incidence of dizziness, hypotension, and cough, but no excess of bleeding, with the administration of the polypill plus aspirin than with a double placebo.

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